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Defects on endoanal ultrasound and anal incontinence after primary repair of fourth-degree anal sphincter rupture: a study of the anal sphincter complex and puborectal muscle

Sakse, A.; Secher, N. J.; Ottesen, M. and Starck-Söndergaard, Marianne LU (2009) In Ultrasound in Obstetrics & Gynecology 34(6). p.693-698
Abstract
Objectives To perform three-dimensional endoanal ultrasound (EA US) after primary repair of fourth-degree anal sphincter rupture (ASR) and correlate the sonographic defects with anal incontinence (AI); to measure the axial and sagittal thickness and angle of the puborectal muscle (PRM) as well as the length of the anal canal, and then correlate these measures with AI; and to assess the interobserver measurement agreement between an inexperienced and an experienced sonologist. Methods EAUS was offered to 84 consecutive women, who were asked to answer a validated questionnaire after fourth-degree ASR. AI was graded according to the Wexner score and EA US defects were graded according to the Starck score. Results Sixty-one women (73%)... (More)
Objectives To perform three-dimensional endoanal ultrasound (EA US) after primary repair of fourth-degree anal sphincter rupture (ASR) and correlate the sonographic defects with anal incontinence (AI); to measure the axial and sagittal thickness and angle of the puborectal muscle (PRM) as well as the length of the anal canal, and then correlate these measures with AI; and to assess the interobserver measurement agreement between an inexperienced and an experienced sonologist. Methods EAUS was offered to 84 consecutive women, who were asked to answer a validated questionnaire after fourth-degree ASR. AI was graded according to the Wexner score and EA US defects were graded according to the Starck score. Results Sixty-one women (73%) answered the questionnaire. The median (range) follow-up time was 5.1. (1.3-8.7) years. Thirty-three (54%) of these women underwent EAUS and were included in the study. There was no difference in the incontinence scores between women who underwent EA US and those who did not. Eleven of the women who underwent EAUS (33%) were continent, 22 women (67%) had flatus incontinence at least once a month, of whom 12 also had incontinence for liquid stool and two had incontinence for solid stool. The median Wexner score was 2 (range, 0-12). Five of the patients (15%) had no ultrasound defects. All of the patients with Wexner scores >= 4 had a Starck score of >= 10. No association between ultrasound defects and AI was demonstrated, however, the angle of the PRM and parity were associated with Starck score. No clear association between the measurements of the PRM and AI was shown. The experienced observer detected more of the small defects than did the inexperienced observer. Conclusion In a 1-9-year follow-up period after primary suture of fourth-degree ASR, the frequency of A I was high, at 67%. No clear association was seen between AI and sphincter defects detected on ultrasonography. There was an association between the angle of the PRM and the extent of ultrasound defects. Copyright (C) 2009 ISUOG. Published by John Wiley & Sons, Ltd. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
fourth, endoanal ultrasound, anal incontinence, anal sphincter rupture, degree, puborectalis muscle
in
Ultrasound in Obstetrics & Gynecology
volume
34
issue
6
pages
693 - 698
publisher
John Wiley & Sons
external identifiers
  • wos:000273077700014
  • scopus:73449088334
ISSN
1469-0705
DOI
10.1002/uog.7478
language
English
LU publication?
yes
id
5fcb88f0-7682-4aff-866c-4467f1defb56 (old id 1531812)
date added to LUP
2010-01-29 12:09:05
date last changed
2017-04-23 04:03:11
@article{5fcb88f0-7682-4aff-866c-4467f1defb56,
  abstract     = {Objectives To perform three-dimensional endoanal ultrasound (EA US) after primary repair of fourth-degree anal sphincter rupture (ASR) and correlate the sonographic defects with anal incontinence (AI); to measure the axial and sagittal thickness and angle of the puborectal muscle (PRM) as well as the length of the anal canal, and then correlate these measures with AI; and to assess the interobserver measurement agreement between an inexperienced and an experienced sonologist. Methods EAUS was offered to 84 consecutive women, who were asked to answer a validated questionnaire after fourth-degree ASR. AI was graded according to the Wexner score and EA US defects were graded according to the Starck score. Results Sixty-one women (73%) answered the questionnaire. The median (range) follow-up time was 5.1. (1.3-8.7) years. Thirty-three (54%) of these women underwent EAUS and were included in the study. There was no difference in the incontinence scores between women who underwent EA US and those who did not. Eleven of the women who underwent EAUS (33%) were continent, 22 women (67%) had flatus incontinence at least once a month, of whom 12 also had incontinence for liquid stool and two had incontinence for solid stool. The median Wexner score was 2 (range, 0-12). Five of the patients (15%) had no ultrasound defects. All of the patients with Wexner scores >= 4 had a Starck score of >= 10. No association between ultrasound defects and AI was demonstrated, however, the angle of the PRM and parity were associated with Starck score. No clear association between the measurements of the PRM and AI was shown. The experienced observer detected more of the small defects than did the inexperienced observer. Conclusion In a 1-9-year follow-up period after primary suture of fourth-degree ASR, the frequency of A I was high, at 67%. No clear association was seen between AI and sphincter defects detected on ultrasonography. There was an association between the angle of the PRM and the extent of ultrasound defects. Copyright (C) 2009 ISUOG. Published by John Wiley & Sons, Ltd.},
  author       = {Sakse, A. and Secher, N. J. and Ottesen, M. and Starck-Söndergaard, Marianne},
  issn         = {1469-0705},
  keyword      = {fourth,endoanal ultrasound,anal incontinence,anal sphincter rupture,degree,puborectalis muscle},
  language     = {eng},
  number       = {6},
  pages        = {693--698},
  publisher    = {John Wiley & Sons},
  series       = {Ultrasound in Obstetrics & Gynecology},
  title        = {Defects on endoanal ultrasound and anal incontinence after primary repair of fourth-degree anal sphincter rupture: a study of the anal sphincter complex and puborectal muscle},
  url          = {http://dx.doi.org/10.1002/uog.7478},
  volume       = {34},
  year         = {2009},
}